A “Health care facility or organization” means a health care facility licensed under Chapter 144 or 144A, or a charitable
organization within the meaning of section 501 (c ) (3) of the Internal Revenue Code.

Provide evidence that the provision of health care services to the uninsured and underinsured is the primary purpose of the facility or organization.

Certify that it maintains adequate general liability and professional liability insurance for program staff other than the volunteer health care provider or is properly and adequately self-insured.

Agree to provide proof of insurance upon registration / renewal / and upon insurance renewal. Provide the Volunteer Participant Roster (Form B) to ASU with the application and the annual renewal form each year. The roster includes data from the individuals participating in the health care provider program currently or individuals that you anticipate will register in the program. The Volunteer Participant Roster form is due by August 31st each year.

Provide the Volunteer Demographics (Form D) to ASU with the application and the annual renewal form each year. The information includes data from the individuals participating in the health care provider program currently or individuals that you anticipate will register in the program. The Volunteer Demographics form is due by August 31st each year.

Enclose $50.00 with the registration application and the renewal form each year. These fees must be in U.S. currency. Make checks payable to Administrative Services Unit. This is due by August 31st each year.

Registration period is October 1st to September 30th. This is an annual registration that expires September 30th each year. You are responsible for completing the renewal registration by August 31st of each year. ASU will not notify you of this renewal date.

To participate as an individual health care provider seeking individual medical malpractice insurance coverage, the
applicant must register with ASU by completing: 1) the Registration Form (Form E)

Be licensed in the state of Minnesota,

Must need malpractice insurance for your volunteer service,

Must know the name of the clinic or facility registered with where you are providing volunteer services,

Registered as a volunteer with the Administrative Services Unit as a Volunteer Health Care Provider,

Complete an application form as an Individual Health Care Provider Registration (Form E).

Comply with any risk management and loss prevention policies imposed by the insurer and the state of Minnesota Risk Management directives per the insurance policy.

Registration period is May 1st to April 30th. This is an annual registration that expires April 30th.

The individual health care provider (volunteer) must complete a registration form (Form E) every year. This must
be submitted by April 1st prior to the expiration of the registration. ASU will not notify you of this renewal date.

The individual health care provider must notify the Administrative Services Unit in writing immediately upon
ending volunteer services and requesting an end to the insurance coverage.

The approximate time to complete and process the registration is 5 to 10 days in the Administrative Services Unit.

There is no fee assessed to individuals registering for the program.

To access either Registration form via the internet, and to obtain a copy of the Voluntary Health Care Provider Program,
access the Administrative Services Unit Webpage at www.asu.state.mn.us.

Currently online registration / renewal for this program are not available. VHCPP Instructions